Department of Cardiovascular Medicine, Yibin First People's Hospital, Yibin, China.
Department of Cardiovascular Medicine, Xinqiao Hospital Affiliated to Army Military Medical University, Chonqing, China.
Ann Palliat Med. 2021 Apr;10(4):4532-4538. doi: 10.21037/apm-21-549.
Non-valvular atrial fibrillation (NVAF) is a common type of AF, and patients with NVAF have a higher risk of ischemic stroke than non-AF patients. This study aims to investigate the goal attainment of international normalized ratio (INR) in patients with NVAF after anticoagulation therapy, and to analyze the risk factors that affect the goal attainment of INR.
NVAF patients who were admitted to our hospital from December 2019 to December 2020 and received anticoagulation therapy were selected as the research subjects. The INR goal attainment of patients was assessed, the risk factors affecting INR goal attainment were analyzed, and a ROC curve was drawn to evaluate the predictive value of risk factors for INR goal attainment in NVAF patients.
After anticoagulation treatment, the INR of 42 cases reached the target (INR value ≥0.2, the goal attainment group), and the INR of 74 cases did not reach the target (INR value <2.0, the non-goal attainment group). The age, mean platelet volume (MPV), platelet distribution width (PDW), and large platelet ratio (P-LCR) levels of patients in the goal attainment group were significantly lower than those in the non-goal attainment group, and the platelet count (PLT) level was higher than that of the non-goal attainment group (P<0.05). The results of multivariate logistic regression analysis showed that MPV, PDW, and P-LCR were independent risk factors that affected the failure in INR goal attainment in patients with NVAF after anticoagulation therapy. The ROC curve showed that the AUC values of MPV, PDW, and P-LCR were 0.711, 0.748, 0.867, respectively, and the combined AUC was 0.876, which was higher than that of the single detection.
MPV, PDW, and P-LCR are important factors that affect the goal attainment of INR after anticoagulant therapy in NVAF patients. For patients with risk factors, clinicians can formulate a reasonable individualized anticoagulant drug regimen based on the above-mentioned index levels.
非瓣膜性心房颤动（NVAF）是一种常见的房颤类型，NVAF 患者发生缺血性脑卒中的风险高于非房颤患者。本研究旨在探讨 NVAF 患者抗凝治疗后国际标准化比值（INR）的达标情况，并分析影响 INR 达标情况的危险因素。
选取 2019 年 12 月至 2020 年 12 月我院收治的 NVAF 患者，入选患者均接受抗凝治疗，评估患者 INR 达标情况，分析影响 INR 达标情况的危险因素，绘制 ROC 曲线评估危险因素对 NVAF 患者 INR 达标情况的预测价值。
抗凝治疗后，42 例患者 INR 达标（INR 值≥0.2，达标组），74 例患者 INR 未达标（INR 值<2.0，未达标组）。达标组患者年龄、平均血小板体积（MPV）、血小板分布宽度（PDW）、大血小板比率（P-LCR）水平均显著低于未达标组，血小板计数（PLT）水平显著高于未达标组（P<0.05）。多因素 logistic 回归分析结果显示，MPV、PDW、P-LCR 是影响 NVAF 患者抗凝治疗后 INR 达标失败的独立危险因素。ROC 曲线显示，MPV、PDW、P-LCR 的 AUC 值分别为 0.711、0.748、0.867，联合 AUC 值为 0.876，均高于单项检测。
MPV、PDW、P-LCR 是非瓣膜性心房颤动患者抗凝治疗后 INR 达标情况的重要影响因素。对于存在危险因素的患者，临床医生可根据上述指标水平制定合理的个体化抗凝药物治疗方案。
